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Percutaneous vertebroplasty and kyphoplasty for pathologic vertebral fractures in the Medicare population: safer and less expensive than open surgery.
J Vasc Interv Radiol. 2012 Nov; 23(11):1423-9.JV

Abstract

PURPOSE

To compare cost and outcomes of surgical and percutaneous treatments of pathologic vertebral fractures.

MATERIALS AND METHODS

Standard Medicare 5% anonymized inpatient files (1999-2009) were retrospectively reviewed. Patients with a diagnosis of vertebral fracture without spinal cord injury and primary or metastatic bony malignancy were divided into percutaneous or surgical groups based on whether they received vertebroplasty/kyphoplasty or surgical treatment. Patients who had no intervention or both interventions were excluded. Cost, length of stay, and type of discharge were examined while controlling for demographic and comorbidity variables.

RESULTS

A total of 451 patients were included; 52% received percutaneous treatment and 48% received surgery. Patients treated percutaneously were older (P < .001) and more likely to be female (P = .04). Percutaneous therapy predicted $14,862 less Medicare cost and $13,565 less overall cost (P < .001 for both), and 4.1 fewer inpatient days (P < .001). Patients who underwent surgery had higher odds of death (odds ratio = 3.38, P = .016), discharge to a rehabilitation facility (odds ratio = 3.3, P = .003), and transfer to another inpatient facility (odds ratio = 8.53, P < .001), and lower odds of discharge to home (odds ratio = 0.42, P < .001) and hospice (odds ratio = 0.08, P = .002).

CONCLUSIONS

In a Medicare population with bony malignancy and vertebral fractures, percutaneous therapy predicted significantly reduced cost and length of stay versus surgery. Patients who underwent percutaneous therapy were significantly less likely to die, be transferred, or be discharged to rehabilitation facilities, and were more likely to be discharged to home or hospice.

Authors+Show Affiliations

Department of Imaging, The Queen's Medical Center, Honolulu, HI 96813, USA. mitagakimd@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23101914

Citation

Itagaki, Michael W., et al. "Percutaneous Vertebroplasty and Kyphoplasty for Pathologic Vertebral Fractures in the Medicare Population: Safer and Less Expensive Than Open Surgery." Journal of Vascular and Interventional Radiology : JVIR, vol. 23, no. 11, 2012, pp. 1423-9.
Itagaki MW, Talenfeld AD, Kwan SW, et al. Percutaneous vertebroplasty and kyphoplasty for pathologic vertebral fractures in the Medicare population: safer and less expensive than open surgery. J Vasc Interv Radiol. 2012;23(11):1423-9.
Itagaki, M. W., Talenfeld, A. D., Kwan, S. W., Brunner, J. W., Mortell, K. E., & Brunner, M. C. (2012). Percutaneous vertebroplasty and kyphoplasty for pathologic vertebral fractures in the Medicare population: safer and less expensive than open surgery. Journal of Vascular and Interventional Radiology : JVIR, 23(11), 1423-9. https://doi.org/10.1016/j.jvir.2012.08.010
Itagaki MW, et al. Percutaneous Vertebroplasty and Kyphoplasty for Pathologic Vertebral Fractures in the Medicare Population: Safer and Less Expensive Than Open Surgery. J Vasc Interv Radiol. 2012;23(11):1423-9. PubMed PMID: 23101914.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous vertebroplasty and kyphoplasty for pathologic vertebral fractures in the Medicare population: safer and less expensive than open surgery. AU - Itagaki,Michael W, AU - Talenfeld,Adam D, AU - Kwan,Sharon W, AU - Brunner,Julian W M, AU - Mortell,Kelly E, AU - Brunner,Michael C, PY - 2012/06/03/received PY - 2012/08/03/revised PY - 2012/08/12/accepted PY - 2012/10/30/entrez PY - 2012/10/30/pubmed PY - 2013/4/16/medline SP - 1423 EP - 9 JF - Journal of vascular and interventional radiology : JVIR JO - J Vasc Interv Radiol VL - 23 IS - 11 N2 - PURPOSE: To compare cost and outcomes of surgical and percutaneous treatments of pathologic vertebral fractures. MATERIALS AND METHODS: Standard Medicare 5% anonymized inpatient files (1999-2009) were retrospectively reviewed. Patients with a diagnosis of vertebral fracture without spinal cord injury and primary or metastatic bony malignancy were divided into percutaneous or surgical groups based on whether they received vertebroplasty/kyphoplasty or surgical treatment. Patients who had no intervention or both interventions were excluded. Cost, length of stay, and type of discharge were examined while controlling for demographic and comorbidity variables. RESULTS: A total of 451 patients were included; 52% received percutaneous treatment and 48% received surgery. Patients treated percutaneously were older (P < .001) and more likely to be female (P = .04). Percutaneous therapy predicted $14,862 less Medicare cost and $13,565 less overall cost (P < .001 for both), and 4.1 fewer inpatient days (P < .001). Patients who underwent surgery had higher odds of death (odds ratio = 3.38, P = .016), discharge to a rehabilitation facility (odds ratio = 3.3, P = .003), and transfer to another inpatient facility (odds ratio = 8.53, P < .001), and lower odds of discharge to home (odds ratio = 0.42, P < .001) and hospice (odds ratio = 0.08, P = .002). CONCLUSIONS: In a Medicare population with bony malignancy and vertebral fractures, percutaneous therapy predicted significantly reduced cost and length of stay versus surgery. Patients who underwent percutaneous therapy were significantly less likely to die, be transferred, or be discharged to rehabilitation facilities, and were more likely to be discharged to home or hospice. SN - 1535-7732 UR - https://www.unboundmedicine.com/medline/citation/23101914/Percutaneous_vertebroplasty_and_kyphoplasty_for_pathologic_vertebral_fractures_in_the_Medicare_population:_safer_and_less_expensive_than_open_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-0443(12)00806-8 DB - PRIME DP - Unbound Medicine ER -